Abstract
Purpose: The aim of the study was to gain an insight into the optimal management of the infertile couple with the husband suffering from azoospermia.
Methods: One hundred and forty-two intracytoplasmic sperm injection (ICSI) cycles performed with testicular extracted spermatozoa were retrospectively analysed. The following factors were investigated for their possible influence on fertilization, cleavage, damage, pregnancy, and ongoing pregnancy rates; the use of fresh, cryopreserved, and preincubated (24 h) spermatozoa and the etiology of the husbands' azoospermia (obstructive and nonobstructive). All microinjections were performed with apparently normal spermatozoa—a head with a tail of normal length. In 116 cycles at least two embryos were available for transfer.
Results: The overall fertilization, clinical pregnancy, and ongoing pregnancy rates obtained for the 116 cycles were 65.0, 30.2, and 22.4% respectively. Similar outcomes were obtained for cycles using fresh testicular and cryopreserved testicular spermatozoa. Similarly, no significant differences were obtained between the cycles using spermatozoa from obstructive or nonobstructive azoospermic patients. An increase in motility after a 24-h preincubation was observed, and although this group was relatively small (n = 17), a significant improvement in fertilization (73.7%) and pregnancy (53.9%) rate was obtained when the testicular sample was preincubated for 24 h. This improvement prevailed in the obstructive azoospermic group, but was less pronounced in nonobstructive patients.
Conclusions: This study shows that the outcome of fresh and frozen–thawed testicular spermatozoa in ICSI is comparable, obstructive and nonobstructive etiologies perform the same, and that preincubation of testicular spermatozoa results in increased fertilization and pregnancy rates. All testicular biopsies are therefore performed the day before oocyte retrieval, superfluous spermatozoa cryopreserved, and the remaining testicular homogenate preincubated for the 24 h prior to oocyte retrieval. With this regime, most azoospermic patients are treated successfully, irrespective of the use of fresh or frozen–thawed spermatozoa from obstructive or nonobstructive cases.
Keywords: Azoospermia, frozen–thawed testicular spermatozoa, ICSI, testicular spermatozoa, pregnancy
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REFERENCES
- 1.Edirisinghe WR, Junk SM, Matson PL, Yovich JL. Changes in motility patterns during in-vitro culture of fresh and frozen/thawed testicular and epididymal spermatozoa: Implications for planning treatment by intracytoplasmic sperm injection. Hum Reprod. 1996;11:2474–2476. doi: 10.1093/oxfordjournals.humrep.a019141. [DOI] [PubMed] [Google Scholar]
- 2.Balaban B, Urman B, Sertac A, Alatas C, Aksoy S, Mercan R, Nuhoglu A. In-vitro culture of spermatozoa induces motility and increases implantation and pregnancy rates after testicular sperm extraction and intracytoplasmic sperm injection. Hum Reprod. 1999;14:2808–2811. doi: 10.1093/humrep/14.11.2808. [DOI] [PubMed] [Google Scholar]
- 3.Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A. Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril. 1995;63:808–815. doi: 10.1016/s0015-0282(16)57486-x. [DOI] [PubMed] [Google Scholar]
- 4.Gil-Salom M, Romera J, Minguez Y, Rubio C, De los Santos MJ, Remohi J, Pellicer A. Pregnancies after intracytoplasmic sperm injection with cryopreserved testicular spermatozoa. Hum Reprod. 1996;11:1309–1313. doi: 10.1093/oxfordjournals.humrep.a019377. [DOI] [PubMed] [Google Scholar]
- 5.Friedler S, Raziel A, Soffer Y, Strassburger D, Komarovsky D, Ron-El R. Intracytoplasmic injection of fresh and cryopreserved testicular spermatozoa in patients with nonobstructive azoospermia—a comparative study. Fertil Steril. 1997;68:892–897. doi: 10.1016/s0015-0282(97)00358-0. [DOI] [PubMed] [Google Scholar]
- 6.Liu J, Tsai Y-L, Katz E, Compton G, Garcia JE, Baramki TA. Outcome of in vitro culture of fresh and frozen–thawed human testicular spermatozoa. Hum Reprod. 1997;12:1667–1672. doi: 10.1093/humrep/12.8.1667. [DOI] [PubMed] [Google Scholar]
- 7.Oates RD, Mulhall J, Burgess C, Cunningham D, Carson R. Fertilization and pregnancy using intentionally cryopreserved testicular tissue as the sperm source for intracytoplasmic sperm injection in 10 men with non-obstructive azoospermia. Hum Reprod. 1997;12:734–739. doi: 10.1093/humrep/12.4.734. [DOI] [PubMed] [Google Scholar]
- 8.Ezeh UIO, Martin M, Cooke ID, Moore HDM. Correlation of testicular pathology and sperm extraction in azoospermic men with ejaculated spermatids detected by immunoflourescent localization. Hum Reprod. 1998;13:3061–3065. doi: 10.1093/humrep/13.11.3061. [DOI] [PubMed] [Google Scholar]
- 9.Jezek D, Knuth UA, Schulze W. Successful testicular extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: Correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men. Hum Reprod. 1998;13:1230–1234. doi: 10.1093/humrep/13.5.1230. [DOI] [PubMed] [Google Scholar]
- 10.Amer M, Haggar SEL, Moustafa T, El-Naser TA, Zohdy W. Testicular sperm extraction: Impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Hum Reprod. 1999;14:3030–3034. doi: 10.1093/humrep/14.12.3030. [DOI] [PubMed] [Google Scholar]
- 11.Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey P. High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy. Hum Reprod. 1995;10:148–152. doi: 10.1093/humrep/10.1.148. [DOI] [PubMed] [Google Scholar]
- 12.Ghazzawi IM, SarrafMG, Taher MR, Khalifa FA. Comparison of the fertilizing capability of spermatozoa from ejaculated, epididymal aspirates and testicular biopsies using intracytoplasmic sperm injection. Hum Reprod. 1998;13:348–352. doi: 10.1093/humrep/13.2.348. [DOI] [PubMed] [Google Scholar]
- 13.Palermo GD, Schleger PN, Hariprashad JJ, Ergun B, Mielnik A, Zaninovic N, Veeck LL, Rosenwaks Z. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod. 1999;14:741–748. doi: 10.1093/humrep/14.3.741. [DOI] [PubMed] [Google Scholar]
- 14.Emiliani S, Van den Bergh M, Vannin A-S, Biramane J, Verdoodt M, Englert Y. Increased sperm motility after in-vitro culture of testicular biopsies from obstructive azoospermic patients results in better post-thaw recovery rate. Hum Reprod. 2000;15:2371–2476. doi: 10.1093/humrep/15.11.2371. [DOI] [PubMed] [Google Scholar]
- 15.Khalifeh FA, Sarraf M, Dabit ST. Full-term delivery following intracytoplasmic sperm injection with spermatozoa from frozen–thawed testicular tissue. Hum Reprod. 1997;12:87–88. doi: 10.1093/humrep/12.1.87. [DOI] [PubMed] [Google Scholar]
- 16.Ben-Yosef D, Yogev L, Hauser R, Yavetz H, Azem F, Yovel I, Lessing J, Amit A. Testicular sperm retrieval and cryopreservation prior to initiating ovarian stimulation as the first line approach in patients with non-obstructive azoospermia. Hum Reprod. 1999;14:1794–1801. doi: 10.1093/humrep/14.7.1794. [DOI] [PubMed] [Google Scholar]
- 17.Gianaroli L, Magli MC, Selman HA, Colpi G, Belgrano E, Trombetta C, Vitali G, Ferraretti AP. Diagnostic testicular biopsy and cryopreservation of testicular tissue as an alternative to repeated surgical openings in the treatment of azoospermic men. Hum Reprod. 1999;14:1034–1038. doi: 10.1093/humrep/14.4.1034. [DOI] [PubMed] [Google Scholar]
- 18.Windt M-L, Coetzee K. Ongoing pregnancies resulting from intracytoplasmic sperm injection (ICSI) of spermatozoa from frozen–thawed testicular biopsy specimen—two case reports. Andrologia. 1999;31:169–172. doi: 10.1046/j.1439-0272.1999.00261.x. [DOI] [PubMed] [Google Scholar]